Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
AJR Am J Roentgenol. 2012 Mar;198(3):W296-303. doi: 10.2214/AJR.11.7221.
The purpose of this article is to evaluate MRI features of ovarian fibroma and fibrothecoma with histopathologic correlation.
In this retrospective study, preoperative MRI examinations of 35 women (mean age, 49 years; range, 24-86 years) with pathologically proven ovarian fibroma (n = 25) or fibrothecoma (n = 10) were reviewed by two radiologists in consensus. MRI features, including visibility of ovaries, presence of capsule, degeneration, T1 and T2 signal, and enhancement pattern, were recorded and correlated with histopathologic features. After administration of gadopentetate dimeglumine, the maximum percentages of enhancement of fibroma or fibrothecoma, myometrium, and, if present, uterine fibroids (11/35 patients) were compared.
All fibromas and fibrothecomas appeared well defined, with a mean size of 6.36 × 4.81 cm. Ipsilateral and contralateral ovaries were each seen in 89% (31/35) of patients. Most fibromas and fibrothecomas were isointense to hypointense compared with myometrium on T1-weighted (91% [32/35]) and T2-weighted (77% [27/35]) images. Capsule was noted in 63% (22/35) and degenerative changes were noted in 66% (23/35) of patients. Fibromas and fibrothecomas larger than 6 cm more likely showed capsule (p < 0.0001, Fisher exact probability test), degenerative changes (p = 0.003), peripheral subcapsular cystic areas (p < 0.0001), heterogeneous T2 signal (p = 0.001), and heterogeneous enhancement (p = 0.005). At least four of the above five characteristics were present in 93% (14/15) of fibromas and fibrothecomas larger than 6 cm (p < 0.0001). The maximum percentage of enhancement for fibromas and fibrothecomas (63%) was significantly lower than those for myometrium (131%; p < 0.0001) and fibroids (103%; p < 0.0001), without a statistically significant difference between the maximum percentage enhancement of myometrium and fibroids. A maximum percentage of enhancement less than 75% yielded 92% positive predictive value in differentiating fibromas and fibrothecomas from fibroids. Fibrothecomas had a higher maximum percentage of enhancement than did fibromas (p = 0.01).
MRI features of ovarian fibromas and fibrothecomas depend on size, with capsule and degenerative changes common with fibromas and fibrothecomas larger than 6 cm. Fibromas and fibrothecomas enhance less than myometrium and fibroids do, and less than 75% maximum percentage enhancement can help in differentiating fibromas and fibrothecomas from fibroids.
本文旨在通过与组织病理学相关性分析，评估卵巢纤维瘤和纤维卵泡膜细胞瘤的 MRI 特征。
本回顾性研究纳入了 35 名经病理证实患有卵巢纤维瘤（n=25）或纤维卵泡膜细胞瘤（n=10）的女性患者，术前 MRI 检查由两名放射科医生共同进行。记录 MRI 特征，包括卵巢是否可见、包膜是否存在、是否存在变性、T1 和 T2 信号以及强化模式，并与组织病理学特征相关联。对比钆喷替酸葡甲胺（GD-DTPA）增强后纤维瘤或纤维卵泡膜细胞瘤、子宫肌层以及如有子宫纤维瘤（35 例患者中的 11 例）的最大增强百分比。
所有纤维瘤和纤维卵泡膜细胞瘤均边界清晰，平均大小为 6.36×4.81cm。89%（31/35）的患者对侧和同侧卵巢均可见。大多数纤维瘤和纤维卵泡膜细胞瘤在 T1 加权像（91%[32/35]）和 T2 加权像（77%[27/35]）上与子宫肌层等信号或低信号。63%（22/35）的患者有包膜，66%（23/35）的患者有退行性变。大于 6cm 的纤维瘤和纤维卵泡膜细胞瘤更可能有包膜（p＜0.0001，Fisher 确切概率检验）、退行性变（p=0.003）、周边包膜下囊性区（p＜0.0001）、T2 信号不均匀（p=0.001）和强化不均匀（p=0.005）。大于 6cm 的纤维瘤和纤维卵泡膜细胞瘤中，有至少四项上述五种特征的占 93%（14/15）（p＜0.0001）。纤维瘤和纤维卵泡膜细胞瘤的最大增强百分比（63%）明显低于子宫肌层（131%；p＜0.0001）和纤维瘤（103%；p＜0.0001），而子宫肌层和纤维瘤的最大增强百分比无统计学差异。最大增强百分比小于 75%可使纤维瘤和纤维卵泡膜细胞瘤与纤维瘤的鉴别诊断具有 92%的阳性预测值。纤维卵泡膜细胞瘤的最大增强百分比高于纤维瘤（p=0.01）。
卵巢纤维瘤和纤维卵泡膜细胞瘤的 MRI 特征取决于肿瘤大小，包膜和退行性变常见于大于 6cm 的纤维瘤和纤维卵泡膜细胞瘤。纤维瘤和纤维卵泡膜细胞瘤的增强程度低于子宫肌层和纤维瘤，最大增强百分比小于 75%有助于将纤维瘤和纤维卵泡膜细胞瘤与纤维瘤相鉴别。
